Foroughi Max, Abolmaali Sara, Abedi Hamid, Ravenel Theodore
Department of Preventive and Restorative Dentistry, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA 94103, USA.
Department of Endodontics, Medical University of South Carolina, Charleston, SC 29425, USA.
Medicina (Kaunas). 2025 May 9;61(5):874. doi: 10.3390/medicina61050874.
: Successful endodontic treatment requires thorough disinfection and removal of the smear layer to prevent reinfection. However, conventional irrigants like sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) can compromise dentin integrity. This study assessed the efficacy of the Synergistic Microbicidal and Ablative Root canal Technique (SMART), which integrates AromaRoot, a biocompatible irrigation solution based on quaternary ammonium compounds, with 980 nm diode laser activation, to enhance bacterial reduction and smear layer removal. : Sixty extracted single-rooted human teeth were inoculated with and divided into four treatment groups using NaOCl, AromaRoot, and 980 nm laser, either alone or in combination. Bacterial counts were measured as colony-forming units per milliliter (CFU/mL). For smear layer analysis, 56 extracted teeth were prepared and irrigated using EDTA, AromaRoot, and laser activation, followed by scanning electron microscopy to evaluate dentinal tubule exposure. Data were analyzed using Kruskal-Wallis and ANOVA. : The combination of AromaRoot, NaOCl, and laser activation achieved a 99.00% bacterial reduction (from 8082 to 60 CFU/mL, < 0.001), outperforming NaOCl alone (98.34%, 131 CFU/mL). For smear layer removal, AromaRoot with laser achieved 78.5% open dentinal tubules in the apical third, significantly higher than EDTA alone (64.5%, < 0.05), though EDTA remained superior in the coronal third (89.0% vs. 81.0%, > 0.05). : The SMART technique significantly improves both disinfection and smear layer removal in root canal therapy, particularly in the apical region. These findings suggest that AromaRoot, especially when laser-activated, may serve as a safe and effective alternative to conventional irrigants, warranting further clinical evaluation.
成功的根管治疗需要彻底消毒并去除玷污层以防止再感染。然而，传统冲洗剂如次氯酸钠（NaOCl）和乙二胺四乙酸（EDTA）会损害牙本质完整性。本研究评估了协同杀菌和消融根管技术（SMART）的疗效，该技术将基于季铵化合物的生物相容性冲洗液AromaRoot与980 nm二极管激光激活相结合，以增强细菌清除和玷污层去除效果。60颗拔除的单根人牙接种细菌后，使用NaOCl、AromaRoot和980 nm激光单独或联合分为四个治疗组。细菌计数以每毫升菌落形成单位（CFU/mL）衡量。对于玷污层分析，制备56颗拔除的牙齿，使用EDTA、AromaRoot和激光激活进行冲洗，随后进行扫描电子显微镜检查以评估牙本质小管暴露情况。数据采用Kruskal-Wallis和方差分析进行分析。AromaRoot、NaOCl和激光激活联合使用实现了99.00%的细菌清除率（从8082降至60 CFU/mL，P<0.001），优于单独使用NaOCl（98.34%，131 CFU/mL）。对于玷污层去除，AromaRoot联合激光在根尖三分之一处实现了78.5%的开放牙本质小管，显著高于单独使用EDTA（64.5%，P<0.05），尽管EDTA在冠部三分之一处仍更具优势（89.0%对81.0%，P>0.05）。SMART技术在根管治疗中显著改善了消毒和玷污层去除效果，尤其是在根尖区域。这些发现表明，AromaRoot，特别是在激光激活时，可能作为传统冲洗剂的安全有效替代品，值得进一步临床评估。
